Lifelong Learning Programme

This project has been funded with support from the European Commission.
This web site reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

This section of the Softis-Ped portal provides administrative information for the project contractual partners and for the European Commission and it is password protected.

Training for Paediatricians and Paediatric Students

Homepage > Training > Training for Paediatricians and Paediatric Students

This training package is addressed to students and medical practitioners in paediatrics on how to autonomously learn, develop and consolidate their soft skills for improving the quality of paediatric services.

Communicating with Health Care Staff

Table of Content

5.5 – Rapid Decision Making
Timing is one of the six attribute of health quality with patient centered needs, safe, efficacy, effective and equity (Hunink, 2014). Decision-making is a fundamental process to health policy and medical practice. Improving decision-making skills and developing optimal decision-making strategies can therefore greatly contribute to improving health care. The standard model of “homo oeconomicus” suggests that human behavior is universally based on intentional and controlled thought, error-free and aimed at maximizing benefits regardless of social context and emotional influences. But actually social interaction in rarely guided entirely by reason. Literature studies show in fact that people during decision –making processes are influenced by interpersonal and emotional aspects (Tversky & Kahneman, 1974; Gigerenzer, 2007). Moreover as the health outcomes are probabilistic, most decisions are made under conditions of uncertainty and ambiguity. Different strategies for making decision under condition of uncertainty have been observed. People can for example examine exhaustively an option and then move to the other or consider alternatives at the same time instead.

Decision-making can also be influenced by risk perception that makes people use heuristics i.e. cognitive shortcuts that simplify evaluation process and allow to achieve a quicker decision-making (Tversky & Kahneman, 1974; Gigerenzer, 2007). Heuristics are efficient cognitive processes, conscious or unconscious, that ignore part of the information, they may therefore lead to “cognitive bias” (i.e., systematic and predictable errors in judgment that result from reliance on heuristics). For example, people have a tendency to view losses as looming larger than corresponding gains (‘‘loss/gain framing bias’’—a phenomenon central to prospect theory) to make judgments of likelihood or frequency based on ease of recall rather than on actual probabilities (availability bias), and to allow previously spent time, money, or effort to influence present or future decisions (sunk-cost effect) (Blumenthal-Barby and Heather Krieger, 2015). Because using heuristics saves effort, the classical view has been that heuristic decisions imply greater errors than do “rational” decisions as defined by logic or statistical models (Gigerenzer and Gaissmaier, 2011). This uncertainty may concern the diagnosis, the accuracy of the available diagnostic tests and the effects of the treatment. Ambiguity can be generated by data variations and different possibilities for interpreting information.

In highly complex situations such these it can be very difficult to manage the information adequately and consider all the options available.

Professionals in a pediatric staff are continuously called to make decisions in situations that are often complex and characterized by uncertainty. To do this they must identify the relevant information (an exam, a symptom etc.), choose a course of action (a surgery, prescription of a drug, etc.), then act. Decisions need to be taken in a rational way and in accordance with the principles of logic considering the information available. In particular, it becomes very important to adequately define the problem, to consider it from different perspectives, and to focus on the final objective.

Nevertheless it is often common to use simpler cognitive strategies or heuristics, which however can sometimes lead to mistakes.

To reduce uncertainty, healthcare professionals use often to consult a colleague for a second opinion. Shared decision-making process allows better access to information and a better possibility to process the available data. To be effective it requires however the construction of a good relationship between pediatric staff professionals. The use of the multidisciplinary working group within the decision-making process can be a great advantage for professionals, allowing them to compare, collect feedback and work on effective goal management methodologies.
Practical Applications
  • Rapid decision making and joint responsibility of nurses in a Problems in understand each other between pediatrician and nurse of Triage, about the attribution of the "Treatment area" in Emergency for the child with "Red Code".
  • Case study. Communication between pediatric nurses about decision makingError in recognize a message coming from a nurse: sometimes it could happen that the pediatrician doesn’t recognize what reported by the nurse on the aggravation of the patient or the need to alert the colleague anesthesiologist, as required by the protocol of PEWS (Pediatric Advanced Warning System). This problem occurs more easily in communication between nurse and doctor.
Online Resources

Table of Content

Follow us

This project has been funded with support from the European Commission. This web site reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.